This T32 renewal application seeks to continue a highly successful postdoctoral training program in cardiovascular outcomes research. It is designed to meet a regional and national need for more scholars in cardiovascular outcomes and quality of care research, especially as healthcare reimbursement transitions from rewarding volume to emphasizing value. It extends and improves the Mid America Heart Institute/University of Missouri-Kansas City (UMKC)?s outcomes research training program, which is unique in the Midwest and serves as the central unifying research program for our region (2 medical schools (UMKC and University of Kansas) and 4 hospital systems). Our program provides a robust foundation with which young investigators can acquire the techniques of cardiovascular outcomes and quality of care research and our objective is to recruit and mentor outstanding potential researchers who are motivated to learn and apply outcomes research principles and techniques in performing comparative effectiveness research and translating existing knowledge to clinical practice. Our 19 multi-disciplinary faculty and 6 advisors are independently funded and specialize in team-based science and collaboration. The 2-year training program has 3 synergistic components: 1) a basic foundation of in clinical research (including a Masters degree in bioinformatics with a clinical research emphasis), 2) specialized skills for outcomes research coupled with academic ?survival skills? (our outcomes-based core curriculum), and 3) hands-on research. Hallmarks of the research experiences include multi-disciplinary group mentorship, individualized to meet the needs of each trainee; access to numerous existing data sources; access to clinical populations for primary data collection and implementation; and highly experienced statistical support. Enhancements planned for the existing program include adding new curricular offerings in entrepreneurship ? a key skill set to sustain and disseminate proven innovations for improving healthcare ? and new training activities for recruiting individuals from diverse backgrounds. Administering the program will be an experienced program director, supported by well-qualified associate and assistant directors. Leaders in methodological cores (economics and decision analysis; large database analysis; bioinformatics; qualitative and implementation research; study design, methodology and statistics; patient and clinician behavior change; community-based participatory research; entrepreneurship; shared medical decision-making and patient-centered research; multi-disciplinary cardiovascular research; disparities research; and risk models and creation of clinical tools) are committed to supporting the training program, as is an advisory committee of national leaders. Collectively, our committed team will provide a formal training, mentorship and evaluation program to continue and enhance our prior success in supporting the ability of trainees to make significant contributions to the scientific literature and to embark on successful academic research careers.